Gu Xiaoyu, Zhu Li, Li Yingming, Yin Bo, Wang Zhongqiu
Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210009, China.
Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, China.
J Belg Soc Radiol. 2023 Oct 18;107(1):81. doi: 10.5334/jbsr.3214. eCollection 2023.
We characterize computed tomography (CT) and magnetic resonance imaging (MRI) features of bronchogenic cysts (BCs) and analyze misdiagnosis.
The retrospective study consisted of 83 patients with BCs. CT and MRI images were assessed for mass location, maximum diameter, density, calcification, signal intensity, and enhancement pattern. Eighty-three patients underwent CT in which 53 underwent CT. Thirteen patients received both plain and enhanced MR, and only one received just a plain MR.
Eighty-three masses were all solitary, with 71 having a roundish morphology, and twelve having a lobulated or irregular morphology. Sixty-six masses are mediastinal type, four are intrapulmonary type, and 13 are ectopic type. Calcification occurred in 14 lesions. On plain CT, 13 lesions displayed water-like attenuation (-20-20 Hu), and 70 showed soft-tissue attenuation (≥21 Hu). On T1WI, eight masses were hyperintense, three were isointense, and three were hypointense. Fourteen masses were hyperintense on T2WI and (Apparent Diffusion Coefficient) ADC sequence. On (Diffusion Weighted Imaging) DWI, six masses were hypointense and eight were hyperintense. Enhanced T1WI showed seven cases were unenhanced, while six were marginally enhanced. Twenty cases were misdiagnosed as thymomas, eleven as neurogenic tumors, six as lymphangiomas, and two as lung cancer. Five cases were misdiagnosed as other diseases. Patients with BCs underwent MR (42.9%) had a lower rate of misdiagnosis than those who underwent CT alone (53.0%).
The imaging findings of BCs in the chest are generally consistent. Misdiagnosis occurs frequently when CT attenuation values exceed 20 Hu. Diagnostic accuracy of BCs tends to improve with preoperative MR examination.
我们对支气管囊肿（BCs）的计算机断层扫描（CT）和磁共振成像（MRI）特征进行了描述，并分析误诊情况。
这项回顾性研究纳入了83例BCs患者。对CT和MRI图像评估肿块位置、最大直径、密度、钙化、信号强度及强化方式。83例患者接受了CT检查，其中53例进行了CT平扫。13例患者接受了平扫及增强MRI检查，仅1例接受了MRI平扫。
83个肿块均为单发，71个形态呈圆形，12个呈分叶状或不规则形。66个肿块为纵隔型，4个为肺内型，13个为异位型。14个病灶出现钙化。CT平扫时，13个病灶呈水样密度（-20～20Hu），70个呈软组织密度（≥21Hu）。在T1加权成像（T1WI）上，8个肿块呈高信号，3个呈等信号，3个呈低信号。14个肿块在T2加权成像（T2WI）及表观扩散系数（ADC）序列上呈高信号。在扩散加权成像（DWI）上，6个肿块呈低信号，8个呈高信号。增强T1WI显示7例无强化，6例呈边缘强化。20例被误诊为胸腺瘤，11例被误诊为神经源性肿瘤，6例被误诊为淋巴管瘤，2例被误诊为肺癌。5例被误诊为其他疾病。接受MRI检查的BCs患者（42.9%）误诊率低于单纯接受CT检查的患者（53.0%）。
胸部BCs的影像学表现一般具有一致性。当CT衰减值超过20Hu时，误诊频繁发生。术前进行MR检查，BCs的诊断准确性趋于提高。
